The Impact of Nursing Education on eSET Sue Jasulaitis RNC, MS
Clinical Research Manager Fertility Centers of Illinois
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3 Interesting Facts ??
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Song
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Learning Objectives Review the eSET trends in the US Describe
an optimal eSET program Discuss effects of lifestyle factors on
fertility Discuss the nurses role in patient education geared
towards maximizing eSET
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Nursing Leaders They Love What They Do They Understand What
They Do They Communicate What They Do
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Greatest REI Challenge Reduce the risk of multiples without
adversely affecting PRs eSET benefits have been fully reported..
BUT!
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Contributing Factors Increase Risk of Multiple Gestation
Increased patient urgency Lack of health insurance coverage
Multiple birth rates are lower in clinics with comprehensive health
care insurance! Competitive pressure BUT I WANT TWINS!
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Universal Goal Universal goal of all fertility treatment
Healthy Full-term Singleton Delivery
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ASRM/SART Practice Guidelines Established in 1998, provides
recommendations on practice guidelines Since 1998, the rate of
high-order multiples have decreased, but the rate of twins
INCREASED! In 2000, more than 2/3 of US ETs = 3+ embryos! SART eSET
rates Gianaroli et al, 2012, Sart 2015 SART >35eSET
RateTwinsTriplets 201111.730.81.2 201214.829.51.1
201322.528.30.9
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Current ASRM Guidelines Practice Committee of ASRM, 2013
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eSET Survey of all SART-Registered IVF Centers Study results :
86% of centers reported doing eSET eSET accounts for >20% of all
transfers 76% = Blastocyst only 34% = Blastocyst and cellular
embryos 47% of centers state they do not have a standard criteria
for eSET All centers from mandated states reported doing eSET 2011
SART results Average number of embryos transferred >35 = 1.9%
FIRST TIME EVER! Kaye et al, 2013
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All Single Embryo Transfers are Not Created Equal! mSET:
Medically Indicated SET neSET: Non-elective SET cSET: Compulsory
SET eSET: Elective SET
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Criteria for eSET < 35 years of age More than 1 top quality
embryos for transfer At least 1 top quality embryo for elective
freezing Previous IVF success No (or 1) past IVF failure Donor egg
recipient Practice Committee ASRM, 2013
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Advances in Embryo Science Blastocyst culture Changes in
culture conditions Improved embryo cryopreservation/vitrification
Improved technology for PGS Use of time-lapsed imaging
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Nursing Impact eSET starts WAY before transfer! EDUCATION IS
THE KEY!
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Patient Education Patients are making decisions based on short
term outcomes without fully considering long term
consequences!
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Overview of Maternal-Perinatal Outcomes Maternal
Complications/Morbidity Pre-eclampsia Venous thrombosis Postpartum
hemorrhage Gestational Diabetes HTN PROM Increasing rages of
c-section DEATH (peri and postpartum) Practice Committee ACOG,
2013, Practice Committee ASRM, 2011
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Peri-Natal Complications/Morbidity Prematurity (LBW, VLBW) NICU
admission Increased rates of jaundice, sepsis Respiratory
compromise /Chronic lung disease Increased rates of CP Learning
disabilities Developmental delays Behavioral difficulties DEATH
ACOG committee opinion, 2013, Practice Committee ASRM, 2011
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Multi-Fetal Pregnancy Reduction Primary risk: Fetal loss and
preterm delivery Limited data, but MFR appears to have the most
benefit with quads or higher Vanishing twins account for 12-38% of
twins. Upon delivery, the surviving twin still has a lower birth
weight than a singleton counterpart If the vanishing twin loss is
> 8 weeks of gestation, the effects are the same as MFR! Ethical
and psychological trauma ACOG committee opinion, 2013; Pinborg,
2005.
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Cost of Multiple Births 3% of all live births in the US are
multiples 2010 Healthcare Costs Singleton: $11,000-$21,ooo Twins:
$105,000 Triplets: $400,000 Novel Insurance Study Comparison of the
cost savings between eSET and DSET ANNUAL COST SAVINGS OF $151
MILLION Jaslow, 2013
BMI Well known fact that obesity decreases PR! Obesity Effects
Sub-fertility Drop in PR as much as 50%! Miscarriages Adverse
pregnancy outcomes Optimal BMI is 19-25 FCI Study of approximately
2,000 patients BMI affected PR in the younger population (under 37)
BUT! The effects diminished with age Male obesity also affects
semen quality and is age dependant! Jungheim eta l, 2012; Paash, et
al, 2010; Uhler et, al 2006;
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Diet Best fertility diet? High protein, low carbs High fat
content produces lower PRs Diet composition study (n=120)
Patients
